Provider Demographics
NPI:1891760310
Name:PAGANO, MICHELA (ATC/L)
Entity Type:Individual
Prefix:
First Name:MICHELA
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7959 W BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2906
Mailing Address - Country:US
Mailing Address - Phone:708-867-0053
Mailing Address - Fax:
Practice Address - Street 1:7959 W BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60631-2906
Practice Address - Country:US
Practice Address - Phone:708-867-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0021942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer